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Everyday Health: Many dentists say that the mouth is the window to the body's health. What's the connection between oral and dental health and conditions such as heart disease and diabetes?

James E. Jacobs, DMD (on Everyday Health)Periodontist, New York City Research over the last 10 years has linked systemic disease to oral disease. Remember that it is all one body with the same immune system, blood supply, allergies, and protective defense systems. Dental school has been separated from medical school, but we must consider the body as a whole. Research shows there is a strong correlation between certain systemic diseases such as diabetes, cardiovascular disease, thyroid disease, and cancer. There are several others as well. The bacterial plaque in our mouths, decay in our teeth, cancer of the oral tissues, salivary gland conditions, allergies in the mouth, and the fact that the mouth is the organ that begins the digestion process have strong relationships systemic diseases — either causing or exacerbating them.

Eugene Antenucci, DDS, FAGD ( knowyourteeth.com)Academy of General Dentistry spokesperson Oral health means more than just an attractive smile. Poor oral health and untreated oral diseases and conditions can have a significant impact on quality of life. And in many cases, the condition of the mouth mirrors the condition of the body as a whole. Recent reports indicate a relationship between periodontal (gum) disease and stroke, heart disease, and preterm babies with low birth-weights. Likewise, more than 90 percent of all systemic diseases have oral manifestations, meaning your dentist may be the first health care provider to diagnose a health problem.

Cardiovascular Disease: Studies suggest a link between gum disease and cardiovascular disease. The current theory is that bacteria present in infected gums can come loose and move throughout the body. Researchers are unsure what causes the bacteria to become mobile, but it has been suggested that bacteria can be dislodged and enter the bloodstream during tasks as simple as brushing, flossing or even chewing. If bacteria reach the arteries, they can irritate them and cause arterial plaque to accumulate, which can cause hardening of the arteries and decreased or blocked blood flow. Compromised blood flow to your heart can cause a heart attack. Also, arterial plaque can come loose and travel to other parts of the body. If a blockage occurs in the brain, it can cause a stroke.

Diabetes: Because diabetes reduces the body's resistance to infection, the gums are at risk for gingivitis, an inflammation usually caused by the presence of bacteria in plaque. Plaque is the sticky film that accumulates on teeth both above and below the gum line. Without regular dental check-ups, gum disease may result if gingivitis is left untreated. It also can cause inflammation and destruction of tissues surrounding and supporting teeth, gums, bone, and fibers that hold the gums to the teeth. Diabetics may experience burning mouth syndrome and fungal infections, such as thrush and oral candidiasis. Dry mouth also may develop, causing an increased incidence of decay. To prevent problems with bacterial infections in the mouth, your dentist may prescribe antibiotics, medicated mouth rinses, and more frequent cleanings.

Jeffrey Ganeles, DMD (teethtoday.com)Periodontist, Boca Raton, FL There are two answers to this question. First, the mouth is a potential portal of entry to infections and inflammation, which have been linked to or implicated in all sorts of diseases like diabetes, cardiovascular disease, chronic lung disease, and even pancreatic cancer, Alzheimer's disease, and obesity. The common denominator to all of these diseases is inflammation, in which the body mounts an exaggerated response to irritants that causes unintended tissue injury. So if destructive bacteria or bacterial products enter the bloodstream, as in periodontal disease, other conditions can be aggravated or triggered.

Second, the mouth is a relatively easy place to observe changes in one's health, offering a window to the rest of the body. Many metabolic disorders can be observed by changes in oral health including diabetes, some immune deficiencies, leukemia, some autoimmune diseases, nutritional deficiencies, and more. There are also interesting statistical correlations between longevity and tooth loss. There is a staggeringly high mortality rate when someone loses all of his or her teeth. And 50 percent of patients die within seven years after becoming edentulous (meaning they’ve lost teeth). It is not clear if this is just an association or a causal relationship.

Cosmetic Dentist, Boston The connection has to do with inflammation and the C-reactive protein that is released during an inflammatory process. Chronic bleeding gums, gingivitis, and periodontal disease cause the body to be in a state of inflammation, and the body releases many different chemicals to combat the inflammation — this can lead to inflammation of the arteries and vessels around the heart. Diabetes affects small blood vessels and when there is inflammation in the mouth due to oral disease, blood sugar levels can be affected; again, the C-reactive protein is not good for the smaller vessels.

Lawrence Spindel, DDS ( lspindeldds.com)Cosmetic Dentist, New York City, lspindeldds.com There is plenty of evidence that having your teeth cleaned and a mouth free of periodontal disease is good for your health. This is not an entirely new idea. In 1933, Charles Mayo, one of the founders of the Mayo Clinic, was quoted as saying “The presence of dental health is important. Dentistry is a distinctive health service and can extend human life ten years.” Many studies show a correlation between periodontal disease and cardiac disease. Also there is at least one study indicating that treatment of periodontal disease improves vascular function. In addition, evidence indicates that periodontal disease may cause a worsening of a diabetic’s glycemic control. The exact mechanism is still being debated and studied, but the scientific literature makes a strong case for the connection of vascular disease, diabetes control, and periodontal disease.

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